Enhanced Myometrial Vascularity, a Little-Known Complication of Pregnancy: Filling the Knowledge-Gap

Abstract

In the last decades, clinicians reported that patients, after failed or terminated intrauterine or cesarean scar pregnancies, demonstrated increased vascularization of the adjacent uterine muscle layers by ultrasound (US). These "earned" the incorrect diagnosis: uterine arterio-venous malformation (AVM). This misnomer was used without etiologic scrutiny by clinicians and repeated in scientific articles and textbooks. Despite the articles written during the same 10-20 years which tried to encourage caretakers of patients to relinquish the term AVM and use the correct term of enhanced myometrial vascularity (EMV). There still is a degree of ignorance as well as a knowledge gap in the obstetrical and radiological community as to the etiology, pathophysiology, and management of the above clinical entity. This article contains previously published, relevant ultrasound-based data on the subject along with our clinical experience highlighted by examples. We aim to fill this gap by providing illustrative clinical cases of the tools we consider relevant to the clinical diagnosis and management of EMV. We emphasize, that in the majority of cases expectant approach, avoids complications resulting from misdiagnosis and unnecessary treatment as well as pointing out the diagnostic importance of determining the parameters in guiding their treatment.

Keywords: AVM; EMV; cesarean scar pregnancy; enhanced myometrial vascularity; miscarriage; pregnancy.